Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery A Systematic Review and Meta-analysis
Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery A Systematic Review and Meta-analysis
复制标题
DOI：
10.1001/jamanetworkopen.2020.7367
复制
发表时间：
2020-06-25
影响因子：
13.8
通讯作者：
Wen, Xuerong
中科院分区：
文献类型：
--
作者：
Lawal, Oluwadolapo D.;Gold, Justin;Wen, Xuerong
重要性术后长期使用阿片类药物可能与阿片类药物依赖和增加医疗保健使用有关。然而，已发表的研究报告了对长期使用阿片类药物的程度和与患者过渡到长期使用阿片类药物有关的风险因素的不同估计。目的探讨术后长期使用阿片类药物风险增加的患者水平危险因素的发生率和特点。数据来源：检索MEDLINE、Embase和Google Scholar，检索时间为2019年6月30日，检索时间为2019年6月30日。关键词可能包括阿片类止痛药、普通手术、外科手术、持续使用阿片类药物和术后疼痛。资料选择：综述文献7534篇，纳入研究33篇。研究包括18岁或18岁以上的参与者，评估手术后3个月或更长时间的阿片类药物使用，并报告手术后长期使用阿片类药物的比率和调整后的风险因素。数据提取和综合遵循流行病学观察性研究的荟萃分析(MOOSE)和系统回顾和荟萃分析的首选报告项目(PRISMA)报告指南。两名审查员独立评估和提取了相关数据。主要结果和指标采用随机效应模型计算危险因素的加权汇集比和优势比(OR)。结果33项研究共涉及1922743人，其中1854006人(96.4%)来自美国。在有性别和年龄信息的研究中，参与者大多为女性(1031 399人；82.7%)，平均年龄(SD)为59.3岁(12.8岁)。术后长期使用阿片类药物的合并率为6.7%(95%CI，4.5%-9.8%)，但在仅包括基线水平的阿片类药物未成熟参与者的限制性分析中，这一比例降至1.2%(95%CI，0.4%-3.9%)。与长期使用阿片类药物最相关的危险因素包括术前使用阿片类药物(OR，5.32；95%CI，2.94-9.64)或非法可卡因(OR，4.34；95%CI，1.50-12.58)，以及术前诊断为腰痛(OR，2.05；95%CI，1.63-2.58)。不同研究水平的因素没有显著差异，包括大手术和小手术的比较(汇集比率：7.0%；95%可信区间，4.9%-9.9%vs 11.1%；95%可信区间，6.0%-19.4%；P=.20)。在我们所有的分析中，由于异质性而不是抽样误差，存在着很大的变异性。结论和相关性研究结果表明，术后长期使用阿片类药物可能会给公众健康带来巨大负担。看来，诸如主动筛查高危人群等战略应该优先考虑。
Importance Prolonged opioid use after surgery may be associated with opioid dependency and increased health care use. However, published studies have reported varying estimates of the magnitude of prolonged opioid use and risk factors associated with the transition of patients to long-term opioid use. Objectives To evaluate the rate and characteristics of patient-level risk factors associated with increased risk of prolonged use of opioids after surgery. Data Sources For this systematic review and meta-analysis, a search of MEDLINE, Embase, and Google Scholar from inception to August 30, 2017, was performed, with an updated search performed on June 30, 2019. Key words may include opioid analgesics, general surgery, surgical procedures, persistent opioid use, and postoperative pain. Study Selection Of 7534 articles reviewed, 33 studies were included. Studies were included if they involved participants 18 years or older, evaluated opioid use 3 or more months after surgery, and reported the rate and adjusted risk factors associated with prolonged opioid use after surgery. Data Extraction and Synthesis The Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Two reviewers independently assessed and extracted the relevant data. Main Outcomes and Measures The weighted pooled rate and odds ratios (ORs) of risk factors were calculated using the random-effects model. Results The 33 studies included 1 922 743 individuals, with 1 854 006 (96.4%) from the US. In studies with available sex and age information, participants were mostly female (1 031 399; 82.7%) and had a mean (SD) age of 59.3 (12.8) years. The pooled rate of prolonged opioid use after surgery was 6.7% (95% CI, 4.5%-9.8%) but decreased to 1.2% (95% CI, 0.4%-3.9%) in restricted analyses involving only opioid-naive participants at baseline. The risk factors with the strongest associations with prolonged opioid use included preoperative use of opioids (OR, 5.32; 95% CI, 2.94-9.64) or illicit cocaine (OR, 4.34; 95% CI, 1.50-12.58) and a preoperative diagnosis of back pain (OR, 2.05; 95% CI, 1.63-2.58). No significant differences were observed with various study-level factors, including a comparison of major vs minor surgical procedures (pooled rate: 7.0%; 95% CI, 4.9%-9.9% vs 11.1%; 95% CI, 6.0%-19.4%; P = .20). Across all of our analyses, there was substantial variability because of heterogeneity instead of sampling error. Conclusions and Relevance The findings suggest that prolonged opioid use after surgery may be a substantial burden to public health. It appears that strategies, such as proactively screening for at-risk individuals, should be prioritized.